Hasan Tauqeer, MBBS¹, Muhammad Ahmed Zaman, MBBS², Amna Rashid Hanfee, MBBS³, Saman Ali, MBBS, FACR⁴

¹Department of Rheumatology, Aga Khan University Hospital, Stadium Road, ?P. O. Box 350?0, Karachi-7480?0, Pakistan, Email: hasan.tauqeer24@alumni.aku.edu

²Department of Rheumatology, Aga Khan University Hospital, Stadium Road, ?P. O. Box 350?0, Karachi-7480?0, Pakistan, Email: ahmedzamannn@gmail.com

³Department of Rheumatology, Aga Khan University Hospital, Stadium Road, ?P. O. Box 350?0, Karachi-7480?0, Pakistan, Email:  amnarashid001@gmail.com

⁴Department of Rheumatology, Aga Khan University Hospital, Stadium Road, ?P. O. Box 350?0, Karachi97480?0, Pakistan, Email: ali.saman@aku.edu

Corresponding Author: Department of Rheumatology, Aga Khan University Hospital, Stadium Road, P. O. Box 3500, Karachi-74800, Pakistan, Email: hasan.tauqeer24@alumni.aku.edu

Citation: Hasan Tauqeer, Muhammad Ahmed Zaman, Amna Rashid Hanfee, Saman Ali (2025). Lupus Presenting with Evans Syndrome: Two Adult Cases. American J Case Rep Clin Imag. 2025; Nov, 3(1),1-3.

Copyrights © 2025, Hasan Tauqeer, et al., This article is licensed under the Creative Commons Attribution-Non-Commercial-4.0-International-License-(CCBY-NC) (https://amejcaserepclinimag.com/). Usage and distribution for commercial purposes require written permission.

Abstract

Evans syndrome (ES) is a rare autoimmune disorder defined by the coexistence of autoimmune hemolytic anemia and immune thrombocytopenia. Secondary ES, particularly in association with systemic lupus erythematosus (SLE), is uncommon and presents diagnostic and therapeutic challenges. We report two adult women with ES secondary to SLE who presented to a tertiary care hospital in Pakistan. Both patients developed simultaneous cytopenias. One responded well to corticosteroids and azathioprine, while the other had refractory thrombocytopenia and suffered a non-ST elevation myocardial infarction (NSTEMI), but she then stabilized on mycophenolate mofetil. These cases underscore the heterogeneity of ES in adults, highlight the risks of treatment-related complications, and reflect challenges in low- and middle-income countries where access to diagnostics and advanced therapies is limited.

Keywords: Evans Syndrome; Autoimmune Hemolytic Anemia; Immune Thrombocytopenia; Systemic Lupus Erythematosus; Lupus Anticoagulant-Hypoprothrombinemia Syndrome; Low- and Middle-Income Countries.